Discussion: Politics and the Patient Protection and Affordable Care Act

Discussion: Politics and the Patient Protection and Affordable Care Act

RE: Discussion – Week 3

The remains a landmark legislation that offered millions of Americans the opportunity to get a health insurance coverage by lowering the cost of premiums through federal and state governments subsidies. However, the political realm of the policy remains a contentious issue as demonstrated during the Trump administration that was keen on repealing and replacing the act. If the efforts had succeeded, more than 23 million Americans could have lost their health insurance and wide ranging benefits from the act (Nadash et al., 2018).  Lawmakers had attempted to “repeal and replace” the Obamacare through the passage of the American Health Care Act (AHCA). A critical analysis showed that implementing the would increase the cost of premiums and fail to cover individuals in special categories like those with pre-existing conditions

Using the cost-benefit analysis model, the lawmakers, including proponents, discovered that they would lose their re-election because of significant negative impacts of the repeal and replace approach. According to the Congressional Budget Office (CBO), the proposed new law would have denied millions of Individuals access to affordable healthcare. The need for the legislators to get reelected meant that they could not repeal the act as public opinion was against reversing the gains attained through Obamacare (Obama, 2017). The Senate Majority Leader failed to get enough support to have the bill voted for in the Senate after its passage in the House of Representatives.

The number one consideration of legislators is to get re-elected and this implies that they need to reassure their electorate that they are protecting their interests. Public opinions and positions on issues like health care impact voters’ influence. The legislators are elected to champion for and advocate issues, which impact their constituents like better affordable healthcare (Stevens, 2018). The lawmakers could not risk to lose their elective positions by support an unpopular policy which could have deprived them of better healthcare.


Nadash, P., Miller, E. A., Jones, D. K., Gusmano, M. K., & Rosenbaum, S. (2018). A series ofunfortunate events: Implications of Republican efforts to repeal and replace the Affordable Care Act for older adults. Journal of aging & social policy, 30(3-4), 259-281. doi: 10.1080/08959420.2018.1462683.

Obama, B. H. (2017). Repealing the ACA without a replacement—the risks to American health

care. Obstetrical & Gynecological Survey, 72(5), 263-264. doi: 10.1056/NEJMp1616577.

Stevens, C. D. (2018). Repeal and replace? A note of caution for medical school curriculum

reformers. Academic Medicine, 93(10), 1425-1427.

doi: 10.1097/ACM.0000000000002219.

Individuals, regardless of political affiliation, are frequently concerned when they consider perceived competing government interests and their impact on topics of interest to them. The healthcare industry is no exception. Some people believe that local, state, and federal policies and legislation can be aided or hampered by interests other than societal benefit.

Consider that the most important job of a legislator is to be re-elected. Cost can be expressed in both votes and dollars. As a result, it is critical to consider the legislator’s perspective on either promoting or prohibiting

Politics and the Patient Protection and Affordable Care Slayers in NURS 6050 or promoting or opposing a specific initiative in the political landscape

By Day 3 of Week 3

Post an explanation for how you think the cost-benefit analysis in terms of legislators being reelected . Then, explain how analyses of the votes views may affect decisions by legislative leaders in recommending or positioning national policies (e.g., decisions impacting Medicare or Medicaid). Remember, the number one job of a legislator is to be re-elected. Please check your discussion grading rubric to ensure your responses meet the criteria.

To Prepare:

  • Review the Resources and reflect on efforts to repeal/replace the Affordable Care Act (ACA).
  • Consider who benefits the most when policy is developed and in the context of policy implementation.

Many attempts have been made to repeal the Affordable Care Act (ACA) over the years. If done away with, millions of people would lose health insurance. Many of those that would lose coverage are working Americans. It has been said that spending would increase if the ACA were repealed. The Affordable Care Act is a hot topic. If repealed, insurance companies could limit or refuse coverage due to pre-existing conditions. (Cohn, 2020) The Trump Administration made changes and called it the Better Care Reconciliation Act. (Ku et. Al, 2017) The penalty for not having insurance was removed, restrictions to state Medicaid, and deductibles were lessened for low-income people. (Ku et al, 2017)

 The Biden-Harris Administration vowed to boost the ACA. (White House, 2021) With the ACA college students can stay on their parents’ insurance plan until age 26. Biden is also requesting a review for ways to protect people with pre-existing conditions. The pandemic has caused a lot of sickness and there are long term effects from infection. Americans need insurance to receive the treatment for those complications. 

 Legislators use the 3 H’s to make decisions. Head, Heart, and Health are used. Making decisions can be a double-edged sword. Legislators are human and want to make good policy changes, however, at the end of the day it is about getting re-elected. When reviewing policies, a big factor is, “do the American people like it.” Legislators have the most to gain from a policy change. It comes down to telling the people what they want to hear to get re-elected. 

Cohn, J. (2020). The ACA, Repeal, and the Politics Backlash. Retrieved December 15, 2021, from 

Ku, L., Steinmetz, E., Brantley, E., Holla, N., and Bruen, B. (2017). The Better Care Reconciliation Act: Economic and Employment Consequences for States. Retrieved December 15th, 2021, from https://www.commonwealthfund.org/sites/default/files/documents/___media_files_publications_issue_brief_2017_jul_ku_bcra_economic_effects_states.pdf

The White House. (2021). FACT SHEET: President Biden to Sign Executive Orders Strengthening Americans’ Access to Quality, Affordable Health Care. Retrieved December 15, 2021, from 

By Day 6 of Week 3

Respond to at least two of your colleagues* on two different days by expanding on their explanation and providing an example that supports their explanation or respectfully challenging their explanation and providing an example.

RE: Week 3

Your discussion was well written out. I agree that the voices of the people must be heard in order to be reelected. People believe that if any changes are made to the ACA it would  destabilize the people. It’s very important that the policy makers keep in mind that families without coverage can cause a threat and unsustainable cost of health care. Repeal without replacement would cause the number of the uninsured to rise, less families with Medicaid, and less insurance on the job. Studies have found evidence that the ACA contributed to the slowing growth of health care costs in recent years.


The cost of full repeal of the Affordable Care Act. Committee for a Responsible Federal Budget. (2017, January 26). Retrieved December 16, 2021, from https://www.crfb.org/papers/cost-full-repeal-affordable-care-act


The cost of ACA Repeal – Urban Institute. (n.d.). Retrieved December 16, 2021, from http://www.urban.org/sites/default/files/publication/81296/2000806-The-Cost-of-the-ACA-Repeal.pdf

*Note: Throughout this program, your fellow students are referred to as colleagues.

Submission and Grading Information

Grading Criteria

To access your rubric:

Week 3 Discussion Rubric

Post by Day 3 and Respond by Day 6 of Week 3

To participate in this Discussion:

Week 3 Discussion

Grading Criteria

The Patient Protection and Affordable Care Act of 2010 (ACA) is a revolutionary policy. This Act wanted to address social injustices in the American healthcare system. However, this policy has met stiff opposition from Republican legislators who openly opposed it. When Donald Trump came to power, repealing ACA was one of his number one priorities. They, however, did not get the requisite number to repeal ACA since other legislators felt like many Americans would be affected. Many Republican lawmakers started seeing that they may not get reelected if they continued to support the repeal of ACA.

In May 2017, the House of Representatives passed the American Health Care Act (Jost, 2017). This was the first attempt at repealing ACA. The Trump administration wanted to use this act to repeal ACA.  However, this Act would make millions of Americans lose health insurance coverage. AHCA proposed that tax credit be based on age, which would increase healthcare costs. This Act also created the Patient and State Stability Fund, which would reduce premiums by 25% after 2026 (Jost, 2017). This would increase healthcare costs for Americans with preexisting comorbid conditions.

A cost-benefit analysis by Republican lawmakers revealed that they would not get reelected because of the negative effects of repealing. Repealing ACA would lead to millions of Americans losing insurance coverage (Straw & Aron-Dine, 2020). This was the main reason for implementing ACA. ACA aimed to increase insurance coverage to millions of Americans and reduce healthcare costs (Sommers, 2020). Due to reelection purposes, the Senate Majority Leader McConnell found it hard to garner support for AHCA. To protect their political interest, the US senators came up with another proposal known as the Better Care Reconciliation Act of 2017 (Smith & Gibbs, 2017).

Members of Congress and Senators are elected leaders who must be voted for by the public. Due to this, their positions on policies such as Obamacare are influenced by how their electorates feel. Because of this, their interest is reelection and not ACA.


Jost, T. S. (2017). House passes AHCA; HHS acts on regulations. Health Affairs36(6), 982-983.  

Smith, K., & Gibbs, T. E. (2017). The APHA PHACT campaign in action in Delaware. Delaware Journal of Public Health3(4), 6-11.  

Sommers, B. D. (2020). Health insurance coverage: What comes after the ACA? Health Affairs39(3), 502-508.  

Straw, T., & Aron-Dine, A. (2020). Commentary: ACA Repeal Even More Dangerous During Pandemic and Economic Crisis. Center on Budget and Policy Priorities. 

RE: Discussion – Week 3

The Affordable Care Act was enacted by former President Obama in 2010. The goal of the ACA was to make health insurance more affordable and available to the people, expand the medicaid programs statewide, as well as support innovative medical care delivery methods which would hopefully decrease health care costs (ACA). Health care and repealing/replacing the ACA is a hot topic among the political world. The ultimate goal of the politician or legislator is to gain votes and be reelected. Whether a legislator truly believes repealing/replacing the ACA with something different will be beneficial to Americans, they are likely to do so anyway to gain the vote from the community. Politicians desire to secure reelection seems to cause legislators to engage in undesirable activities. Money unfortunately plays a critical role in these election and reelection campaigns, as it costs millions of dollars to win an election even at the local level (Milstead & Short, 2019). Cost benefit analysis plays a huge part in terms of legislators being reelected. Legislators will partner with “527 committees” to gain funds for their campaigns (Milstead & Short, 2019). This can skew their actual viewpoint and opinion on a topic, but due to the necessity of big money needed to win an election, they will partner with these wealthy individuals and employ and project their opinion on a political topic to gain money and votes (Milstead & Short, 2019). The republican party is working on, and has been trying hard, to repeal/replace the ACA in order to gain votes of the people who are not in favor Obamacare, which in turn helps them gain votes for reelection. To do this, the republican party  has tried to implement the Better Care Reconciliation Act, which has cut funding in certain areas, and cost the American people more money in ways (Amadeo, 2018).


ACA. (n.d.) Affordable Care Act- Healthcare.gov Glossary. Retrieved March 11, 2020, from https://www.healthcare.gov/glossary/affordable-


Amadeo, K. (2018, October 17). What a Congressional Plan to Repeal Obamacare Would Look Like. Retrieved March 11, 2020, from


Milstead, J.A., Short, N.M. (2019). Health policy and politics: A nurse’s guide (6th ed). Burlington, MA: Jones & Bartlett Learning.

Health Policy and Politics: The Affordable Care Act

The Affordable Care Act (ACA), famously known as Obamacare, sought to enhance universal healthcare access by making health insurance to be inexpensive for all Americans. ACA targeted individual market, employer-provided benefits, and non-Medicare-eligible population to ensure they accessed affordable and comprehensive insurance coverage without any discrimination on the basis of their health status (Nadash, Miller, Jones, Gusmano, & Rosenbaum, 2018). The Republican Party seeks to stop government interference in the insurance market. It has spearheaded efforts to repeal and replace the ACA through the courts terming it as unconstitutional. Additionally, several states have shown open hostility to the law since it expanded the Medicaid coverage. Besides, House and Senate Republicans have sponsored several repeal initiatives such as Better Care Reconciliation Act (BCRA) and Graham-Cassidy bills (Nadash et al., 2018). The constant onslaught of the ACA from President Trump and Republicans has led to an increase in premiums and several insurers withdrawing from selling the insurance plans in the recent past. The early success of the ACA, whereby millions of Americans secured insurance coverage through the individual markets, subsidies for low-income individuals, and Medicaid, have been eroded.


The Impact of Cost-Benefit Analysis


Milstead and Short (2019) argued that the supporters and critics of ACA include the members of Congress whose main objective is to be re-elected during the election cycles. The opponent’s debates and efforts to repeal and replacement of ACA in both President Obama’s and Trump’s administrations are deliberate for political expediency as opposed to promoting public health and well-being. Furthermore, the political elites do not perform a cost-benefit analysis of the effectiveness of the ACA to enable them to compromise on a bipartisan basis about the contentious issues contained in the law, such as the insurance mandates, Medicaid, insurance plans, and tax credits.


Analysis of Votes


Notably, the ACA resulted in a progressive American tax system whereby the wealthy individuals were obligated to pay higher federal taxes, 3.8% more on taxes on unearned income and a 0.9% increase in Medicare payroll taxes. The new tax revenue was earmarked to fund the expansions proposed by the ACA (Grogan, 2017). Additionally, the law delimited the out-of-pocket costs for marketplace insurance coverage, specifically $13,200 and $6,600 for family and individual plans (Grogan, 2017). The subsidies and financing options of ACA ensured equitable access to healthcare and lowered the financial burden of healthcare costs for the majority of low-income Americans. According to Congressional Budget Office, The Joint Committee on Taxation, and The Center on Budget and Policy Priorities (as cited in Grogan, 2017), repealing and replacing the ACA will increase Medicaid costs by over $370 billion over the next decade, which would be covered by the states. Besides, eliminating tax directives will benefit the wealthiest people since they will be able to save almost $600 billion through 2026 (Grogan, 2017). Despite such cost-benefit analysis being conducted to determine the effect of repealing and replacing ACA, the legislators focus on their re-election prospects while discussing the merits and demerits of Obamacare. The lawmakers’ support for ACA must be consistent with the views of their electorates and donors. For instance, voting against the Act would have been contrary to the desires of most Republicans, and they risked losing their elective seats in the House or Senate.


 It is evident that ACA not only resulted in national Medicaid expansions and subsidized Marketplace coverage, but it also reduced the cost of medical care and improved access to health services for patients in various age groups. These results would be what any leader would like to experience in their country, that is easy access to affordable and quality care for all people. Nevertheless, legislators would be willing to disregard these benefits to the society if all their chances of re-election would not be increased by them supporting the ACA. It is on the same basis that members of Congress will make decisions on whether to reject or recommend national policies concerning Medicaid/Medicare. Politicians rely on donors and lobbyists for financial support to win their elections. In healthcare, these funders could be medical organizations that are negatively affected by the particular policy under deliberation. As such, to ensure that they continue to receive support from these agencies, legislators have to cater to the interest of their donor and vote to reject a policy that could otherwise, benefit the society. However, this does not mean that they do not believe passing such a proposal into law would be in the best interest of the public. The members of the U.S. Congress usually align with their left- or right-wing political affiliation and support legislations to appease their electorates, lobbyists, and sponsors purposely to ensure they retain their Senate or House seats as opposed to promoting public good in a bipartisan manner.


Grogan, C. M. (2017). How the ACA addressed health equity and what repeal would mean. Journal of Health Politics, Policy and Law42(5), 985-993.

Milstead, J. A., & Short, N. M. (2019). Health policy and politics: A nurse’s guide (6th ed.). Burlington, MA: Jones & Bartlett Learning.

Nadash, P., Miller, E. A., Jones, D. K., Gusmano, M. K., & Rosenbaum, S. (2018). A series of unfortunate events: implications of Republican efforts to repeal and replace the Affordable Care Act for older adults. Journal of Aging & Social Policy30(3-4), 259-281.

RE: Discussion – Week 3- Initial Post

Ever since The Patient Protection and Affordable Care Act (PPACA, Affordable Care Act, ACA, or Obamacare) was signed into law in 2010, Americans have always been on the divide.  The ACA was passed without any Republicans’ signature. After its passage and implementation, half of the states, mostly led by Republicans, challenged the law (Walden University n.d.). The ACA is an example of a significant federal policy that aimed to improve people’s access to health care. Health care access means having the ability to receive the right type of care when needed at an affordable price (Mason et al., 2020).  Americans were skeptical initially because of the number of regulations, taxes, mandates, and subsidies. Opinions changed when the number of uninsured Americans went down.

With the Trump administration and Congress continue to show interest in repealing the ACA, more people said the ACA had a mostly positive effect on the country. More Americans have access to health care without the fear of being denied because of a pre-existing condition. Several ACA provisions make it easier for individuals to get and keep insurance (Patient Protection and Affordable Care Act, 2020).

With the global pandemic, it is essential to have insurance. With millions of Americans who lost their jobs, millions of them become uninsured. But with ACA, the newly unemployed were able to get health coverage through the ACA marketplace with financial assistance to make their coverage affordable or through Medicaid expansion. The COVID pandemic has influenced public opinion regarding health insurance coverage. The public influence will then affect their legislator’s view as the legislator needs votes to get reelected. If they represent an area with high unemployment, they will most likely be on the side to keep the ACA or replace it with another program that offers even more health insurance exchanges.


Mason, D. J., Gardner, D. B., Outlaw, F. H., & O’Grady, E. T. (2020). Policy & politics in nursing and health care – E-book. Elsevier Health Sciences.

Patient protection and affordable care Act. (2020, March 26). Brain Injury Association of America.

Walden University. (n.d.). An Introduction to Health Policy and Law Program Transcript. https://class.content.laureate.net/9e8e1f08ee35476e91f0bca97ae86ae1.html#section_container_20

RE: Discussion – response 2

                 Karen, I enjoyed reading your post and you offered a lot of information regarding the ACA. While I agree that the purpose of passing the Affordable Care Act was in the best nature of the Americans it was meant to serve, it was met with opposition from the conservative party. Gardner (2013) wrote that creating a new health care structure that involves fundamental change in how providers are paid, how consumers are insured, and how medical care and public health are integrated to safeguard the nation’s health at a sustainable cost, will not happen without difficulties along the way. Although the ACA offers progress on getting more Americans insured it did not transition smoothly with many Americans and legislators alike.

When President Trump took office, his main goal was to repeal the ACA, however without another plan to implement millions of Americans would lose healthcare. Those that opposed the ACA described it as a policy that allows for big government intrusion into individual freedom (Gardner, 2013) which has been the basis for several Supreme Court cases that challenge the validity of the ACA and President Trumps stand on taking away the rights of American freedom to choose.

As congress prepares for their re-election they have been faced with the pressure of repealing/replacing or fixing a broken ACA health care plan. According to Fontenot (2014) it undoubtedly becomes harder to push for repeal as Americans get used to benefits offered through the ACA, but it would also appear the country is simply tired of arguments about the law. The American people want progress and legislation on both sides, but to this day there is still question on the security of our nation’s health care system. According to an article in the Washington Post “some conservative advocates still push legal challenges to the ACA. But overall, Republicans lawmakers, faced with the pandemic’s health-care crisis, have slowed or stopped their efforts to terminate benefits that votes have come to expect (2020). Officials are faced with tough decisions to protect the American people they were elected to serve and balance the opposition to secure a job in the next election. With the expansion of Medicaid those people that have lost their jobs due to the global pandemic can still obtain health insurance coverage in the event they are impacted medically by the pandemic. Many lawmakers have done a cost-benefit analysis based on the goal of securing a their job in the next election and attempting to repeal a law that has provided health care coverage to so many impacted by the pandemic would be political suicide.


Fontenot, S. F. (2014). Politics And A Broken Promise: The ACA Faces Another Election Cycle. Physician Leadership Journal, 1(2), 48-50.

Gardner, D. (2013). Health Policy and Politics. ACA Implementation: A Vulnerable and Misunderstood Endeavor. Nursing Economics, 31(6), 307-306.

Jacobs, L. R., Mettler, S., & Zhu, L. (2020, April 27). Republicans are relying on the Affordable Care Act to respond to the pandemic. The Washington Post. Facing the coronavirus, Republicans now support the Affordable Car Act – The Washington Post


The last statement of  “….their interest is re-election and not ACA.” This statement highlights the level of politics within politics. Interest groups spend resources on trying to remove legislators who do not share in their intentions. Americans would be better served by policy-motivated committees that dissect and evaluate the benefit of a bill before allowing it to be considered (Lorenz, 2020). Everything boils down to the dollar. I understand health care and politics are as much of a business as anything else. However, it is unfortunate the system is overly saturated with misguided interests, and how does this benefit me. Personal experiences weigh heavily on attitudes toward the government and health care policies within contemporary societies (Larson, 2020). Lobbyists aid in providing and identifying agendas; these “agenda setters” would be more likely to perform in the public’s best interest if a policy-motivated committee was the influence behind new bills (Lorenz, 2020).

Larsen, G. (2020. Personal politics? Healthcare policies, personal experiences and government attitudes. Journal of European Social                       Policy.


Lorenz, G. (2020). Prioritized interests: Diverse lobbying coalitions and congressional committee agenda setting. University of Chicago Press Journals.


Hi Sasha, I think your discussion post was a great summary of how beneficial the ACA was and the detriment to the entire population we would have seen if the AHCA had been passed. The elderly population would have suffered the most as far as coverage due to costs, and the younger population would have had a harder time finding accessible care because of constituents based on age. Also, I like that you mentioned that health care costs would increase for Americans with comorbidities, as this has been a growing concern over the years.

Hello Sasha,

Thank you for your response to the discussion. The way you ended your post really stands out and is a little unsettling. It is unfortunate that there are politicians who’s main goal is to keep their position or maintain their image for re-election.  I would hope that the majority of politicians stand by their ethics and vote based off their true feelings and advocate for the populations they represent. I would like to see improvements continue to be made in relation to health care without driving the costs of care up. It is obvious that politicians want to make changes, for example, the Better Care Reconciliation Act was created in order to make changes but not to be as controversial (Smith & Gibbs, 2017). 


Smith, K., & Gibbs, T. E. (2017). The APHA PHACT campaign in action in Delaware. Delaware  Journal of Public Health3(4), 6-11. 


I love that you kept the explanation of the health care acts and attempted repeal short and simple but explained it all perfectly. It is a shame that in recent times, politician’s true colors have shown. They are making it more transparent that some, unfortunately most, do not always have the American people’s best interest in mind. With legislators being driven with the primary goal of being re-elected and not solely for the benefit for its constituents (Milstead & Short, 2019), I am grateful we live in a country that allows us to be a part of a democracy in order to have some control in how our amazing country is ran. According to Dr. Nwogu, “democracy is a system of government with four key elements: a system for choosing and replacing the government through free and fair elections, active participation of the people, as citizens in politics and civic life, protection of the human rights of all citizens and a rule of law in which the laws and procedures apply equally to all citizens” (2015). I genuinely believe, if we allowed these elements to guide our country, the government wouldn’t be viewed as corrupt, and we wouldn’t have to analyze how politicians balance cost vs benefit for their gain instead of the American people like it was originally intended way back when.


Milstead, J. A., & Short, N. M. (2019. Informing public policy: An important role for registered nurses. In Health Policy and Polictics: A nurse’s guide (6th ed., p. 40). Jones and Bartlett Learning.

Nwogu, G. A. I. (2015). Democracy: Its Meaning and Dissenting Opinions of the Political Class in Nigeria: A Philosophical Approach . Journal of Education and Practice6(4). Retrieved 2021, from .

I enjoyed reading your informative discussion board post on the importance and benefits of the Affordable Care Act. Without this bill passed by President Obama, vulnerable populations, the Elderly and young population, cannot receive healthcare services. The affordable care act is essential as it reduces the insurance premium coverage. In turn, patients can pay for doctor’s visits and deliver their medication. Replacing and repealing ACA will affect millions of Americans in a negative way who rely on this act to have their medical needs met. According to

Cusick “The ACA codified protection for people with pre-existing conditions and eliminated patient cost-sharing for high values preventive care (Cusick Director et al., 2021). With that in mind, ACA has helped millions of Americans to afford to pay for health services. Replacing the ACA will not be a good idea.

Great post!


Cusick Director, J., Cusick, J., Director, Director, S. H. A., Hananel, S., Director, A., Seeberger Director, C., Seeberger, C., Oduyeru Manager, L., Oduyeru, L., Manager, Gordon Director, P., Gordon, P., Shepherd Director, M., Shepherd, M., Director, J. P. D., Parshall, J., Director, D., Gee, E., … Simpson, E. (2021, November 2). Ten ways the ACA has improved health care in the past decade. Center for American Progress. Retrieved December 17, 2021, from https://www.americanprogress.org/article/10-ways-aca-improved-health-care-past-decade/

RE: Discussion – Week 3

The IHI Triple Aim is a framework developed by the Institute for Healthcare Improvement that describes an approach to optimizing health system performance. IHI believes that new designs must be developed to simultaneously pursue three dimensions, which we call the “Triple Aim” (IHI, n.d.). The triple aim includes:

  • Improving patient experience and quality of care.
  • Improving health populations.
  • Reducing the per capita cost of health care.

Improving the U.S. health care system requires the simultaneous pursuit of three aims (Berwick e al., 2008).

The U.S. health care system is the most costly globally, accounting for 17% of the gross domestic product with estimates that percentage will grow to nearly 20% by 2020 (IHI, n.d.)

I believe that the triple aim is ambitious yet attainable. However, a careful study of the U.S. health care system and budget would play an essential role in its implementation. To attain an excellent patient experience, hospitals in the U.S. should have adequate health care professionals. One example is the nurse-patient ratio in hospitals. The government should also allocate enough funds to promote care and make health care accessible to every American. Lastly, an additional budget is necessary to subsidize a more significant percentage of patients’ insurance to decrease health care costs.


IHI, n.d. IHI Triple AIM Initiative. Retrieved from


Berwick D., Nolan T., and Whittington J., 2008. The Triple Aim: Care, Health, And Cost. Health Affairs. Retrieved from https://doi.or/10.1377/hlthaff.27.3.759

RE: Discussion – Week 3

Hello Kendra,

This is insightful. Each branch of the federal government has specific responsibilities in serving the populace. The three branches of the government can work together for the greater good of society. Affordable Care policy is one of the policies passed by the legislators to improve healthcare access by all the individuals from socio-economic classes (Gaffney & McCormick, 2017). The policy has enabled millions of people to access healthcare services at affordable costs. In most cases, legislators have diverse objectives when debating on the policies within the healthcare systems (Laureate Education, 2018). Therefore, they may not consider the interest of the people when undertaking legislative processes. For instance, a legislature may oppose or fail to support the legislative process with the hope of retaining their political position in subsequent elections (McIntyre & Song, 2019). However, in some cases, such as emergency situations, legislatures may work together to pass a bill for the interest of the citizens. Besides, the voting process on the legislation may be based on the ideals of the political party.


Gaffney, A., & McCormick, D. (2017). The Affordable Care Act: implications for health-care equity. The Lancet389(10077), 1442-1452.

Laureate Education (Producer). (2018). Introduction to Health Policy and Law with Joel Teitelbaum (Video file). Baltimore, MD: Author.

McIntyre, A., & Song, Z. (2019). The US Affordable Care Act: Reflections and directions at the close of a decade.

The Patient Protection and Affordable Care Act and politics

Politics that are divided and divisiveness have made it difficult for American leaders to reconsider the long-awaited healthcare reforms. There are people who argue that the Affordable Care Act’s present healthcare scheme is economical. According to a cost-benefit analysis, for a program to be cost-effective, its benefits must outweigh the costs associated with its implementation (Milstead & Short, 2019). The Act enables the majority of residents to gain access to healthcare services; consequently, removing it could cause legislators to lose electoral support.

Some political leaders believe that if the Affordable Care Act is repealed, a large number of individuals may lose insurance coverage (Hagan et al., 2017). There is also concern that the repeal of the Act may result in a large loss of employment due to fewer individuals having access to insurance coverage. For instance, if the Act is repealed, a large number of people who obtained insurance coverage through the program for affordable healthcare will automatically lose it. Numerous Americans will become uninsured as a result of the loss of coverage for millions of low-income earners under the Medicaid program. This will impact their access to and ability to afford healthcare treatments.

According to Feldstein, it is improbable that legislators will support the repeal of the Affordable Care Act. This is because, according to a cost-benefit analysis, legislators are only inclined to support a legislative initiative that is more advantageous to them (Feldstein, 2006). On this logic, it is unlikely that they will repeal the Affordable Care Act, as doing so would not benefit the American people. This is demonstrated by the fact that despite President Trump’s efforts to repeal the Act, he has been unable. Even when the republicans controlled Congress, they were unable to garner the support necessary to overturn the law. In this scenario, the benefits of the coat (political support) outweigh the costs (losing political support). Therefore, it is unlikely that they will support the repeal.

RE: Discussion – Week 3

The election or reelection of a politician can have an impact on legislation and votes on new laws. How do voters influence legislative leaders’ decisions? It can have a variety of effects, including forcing politicians to embrace “middle ground” positions. Competition for votes can force Republicans and Democrats to moderate their policy choices (Lee et al., 2004).  As of 2021, the house of Representatives is controlled by Democrats, while Republicans control the Senate. Due to two-thirds checks and balances from the legislative, executive, and judicial departments, it is more difficult to pass laws when the House and Senate are split.  The Affordable Care Act (ACA) is an example of a “middle ground political platform,” as democratic legislators will support it while conservatives strive to remove or amend it. A citizen’s vote for legislators in the United States will have an impact on their decisions.  President Obama declared that a major priority would be health care for all, and in 2010, the Patient Protection and ACA was established, but with the election of President Trump, the republicans majorities in Congress, the ACA was to undergo rigorous redesign or replacement (Milstead & Short, 2019).  President Trump attempted to repeal the Affordable Care Act (ACA) but was unsuccessful due to checks and balances. However, under the Trump administration, the ACA was modified by removing the penalty for anyone who did not obtain health insurance. President Obama financed his campaign by requiring Americans to purchase Obamacare or face financial penalties, but President Trump’s purpose was for the people to choose what they wanted.  Democrats and Republicans are continuing to move pieces in a stalemate chess game. These moves are costing the taxpayers additional money that can be used in better deeds.  In some ways, the ACA impacted Medicaid is by coverage in certain areas.  Many people were forced to drop Medicaid, due to changes in financial requirements and picked up ACA, and not all medical clinics accepted the ACA insurance. Thus, this increased the census of emergency room visits. Results from the Oregon Health Insurance Experiment (OHIE) suggest that Medicaid eligibility expansion under the Affordable Care Act (ACA) will increase emergency department (ED) utilization (Venkatesh & Cutter, 2014). Emergency room census, caseloads, and short staffing are already an issue in hospitals, which will exacerbate issues due to non-emergency room visits.  This type of unnecessary usage of emergency rooms is a waste of resources hospitals end up losing money. Many people who do not qualify for Medicaid and end up using the ER for non-emergency cases will receive high medical bills only making their financial situation worse.


Lee, D. S., Moretti, E., & Butler, M. J. (2004). Do voters affect or elect policies? Evidence from the U.S. house. The Quarterly Journal of Economics119(3), 807–859. 

Milstead, J. A., & Short, N. M. (2019). Health policy and politics (6th ed.). Jones & Bartlett Learning.

Venkatesh, A., & Cutter, C. (2014). 5 Medicaid expansion under the affordable care act: How may it affect emergency department utilization and access? Annals of Emergency Medicine64(4), S3. Retrieved June 10, 2021, from 


Excellent Good Fair Poor
Main Posting
Points Range: 45 (45%) – 50 (50%)

Answers all parts of the discussion question(s) expectations with reflective critical analysis and synthesis of knowledge gained from the course readings for the module and current credible sources.

Supported by at least three current, credible sources.

Written clearly and concisely with no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.

Points Range: 40 (40%) – 44 (44%)

Responds to the discussion question(s) and is reflective with critical analysis and synthesis of knowledge gained from the course readings for the module.

At least 75% of post has exceptional depth and breadth.

Supported by at least three credible sources.

Written clearly and concisely with one or no grammatical or spelling errors and fully adheres to current APA manual writing rules and style.

Points Range: 35 (35%) – 39 (39%)

Responds to some of the discussion question(s).

One or two criteria are not addressed or are superficially addressed.

Is somewhat lacking reflection and critical analysis and synthesis.

Somewhat represents knowledge gained from the course readings for the module.

Post is cited with two credible sources.

Written somewhat concisely; may contain more than two spelling or grammatical errors.

Contains some APA formatting errors.

Points Range: 0 (0%) – 34 (34%)

Does not respond to the discussion question(s) adequately.

Lacks depth or superficially addresses criteria.

Lacks reflection and critical analysis and synthesis.

Does not represent knowledge gained from the course readings for the module.

Contains only one or no credible sources.

Not written clearly or concisely.

Contains more than two spelling or grammatical errors.

Does not adhere to current APA manual writing rules and style.

Main Post: Timeliness
Points Range: 10 (10%) – 10 (10%)
Posts main post by day 3.
Points Range: 0 (0%) – 0 (0%)
Points Range: 0 (0%) – 0 (0%)
Points Range: 0 (0%) – 0 (0%)
Does not post by day 3.
First Response
Points Range: 17 (17%) – 18 (18%)

Response exhibits synthesis, critical thinking, and application to practice settings.

Communication is professional and respectful to colleagues.

Responses to faculty questions are fully answered, if posed.

Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.

Demonstrates synthesis and understanding of learning objectives.

Response is effectively written in standard, edited English.

Points Range: 15 (15%) – 16 (16%)

Response exhibits critical thinking and application to practice settings.

Communication is professional and respectful to colleagues.

Responses to faculty questions are answered, if posed.

Provides clear, concise opinions and ideas that are supported by two or more credible sources.

Response is effectively written in standard, edited English.

Points Range: 13 (13%) – 14 (14%)

Response is on topic and may have some depth.

Responses posted in the discussion may lack effective professional communication.

Responses to faculty questions are somewhat answered, if posed.

Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.

Points Range: 0 (0%) – 12 (12%)

Response may not be on topic and lacks depth.

Responses posted in the discussion lack effective professional communication.

Responses to faculty questions are missing.

No credible sources are cited.

Second Response
Points Range: 16 (16%) – 17 (17%)

Response exhibits synthesis, critical thinking, and application to practice settings.

Communication is professional and respectful to colleagues.

Responses to faculty questions are fully answered, if posed.

Provides clear, concise opinions and ideas that are supported by at least two scholarly sources.

Demonstrates synthesis and understanding of learning objectives.

Response is effectively written in standard, edited English.

Points Range: 14 (14%) – 15 (15%)

Response exhibits critical thinking and application to practice settings.

Communication is professional and respectful to colleagues.

Responses to faculty questions are answered, if posed.

Provides clear, concise opinions and ideas that are supported by two or more credible sources.

Response is effectively written in standard, edited English.

Points Range: 12 (12%) – 13 (13%)

Response is on topic and may have some depth.

Responses posted in the discussion may lack effective professional communication.

Responses to faculty questions are somewhat answered, if posed.

Response may lack clear, concise opinions and ideas, and a few or no credible sources are cited.

Points Range: 0 (0%) – 11 (11%)

Response may not be on topic and lacks depth.

Responses posted in the discussion lack effective professional communication.

Responses to faculty questions are missing.

No credible sources are cited.

Points Range: 5 (5%) – 5 (5%)
Meets requirements for participation by posting on three different days.
Points Range: 0 (0%) – 0 (0%)
Points Range: 0 (0%) – 0 (0%)
Points Range: 0 (0%) – 0 (0%)
Does not meet requirements for participation by posting on 3 different days.
Total Points: 100
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